Introduction: there are different techniques to control surgical pain, precisely in this study post C-section pain. Few studies have examined a possible relationship between the technique used, in this case Tap block vs elastomer, and the control of pain and its consequences on breast-feeding. Objectives: the goal of this study is to provide an assessment of the different pain scales NRS and to identify differences with reference to movement, breast-feeding, sedation and occurrence of nausea and vomiting in two different groups of patients, post-partum hospitalised, who were subjected to different antalgic therapies. Materials and methods: the study has been carried out in two phases, firstly a revision of the specific literature and secondly a collection of data. Sixty-eight women who had a C-section at the Azienda ospedaliera in Padua between the period June-October 2022 were enrolled. The information collected has taken into consideration NRS pain scales, sedation level, movement and occurrence of nausea and vomiting. Two questionnaires concerning breast-feeding were given to the women after delivery and a month later. The data collected have been analysed through statistical tests. Results: 53% of the recruited women were subjected to elastomer as post operative anthalgic therapy, while the remaining 47% went through Tap block. With reference to the NRS pain scales, in the first 6 hours after delivery the average pain in the patients with elastomer proved to be 5,88, while it was 4.19 in the patients with Tap block. Despite this difference, from a statistical point of view no report statistically relevant has emerged. From the obtained p-values, only the data concerning movement have shown a statistically relevant report. Actually, 56,3% of the Tap block patients stood up from bed within 6-12 hours after delivery, while 27% of the patients with elastomer did not. With reference to the other variables, among which the level of sedation and the occurrence of nausea and vomiting, no relevant differences have emerged in the two groups. Finally, the analysis of the answers of the questionnaires have revealed no statistically relevant considerations, but they have shown that women treated with Tap block exclusively breastfed their babies both in the first days after delivery and after a month. In both groups, the majority of patients had skin – to- skin contact with their babies (69%-78%) and first breast-feed (80%-75%) in the first hours, they did not face any difficulties (41%-31%) after a month from delivery and continued to breastfeed during the analysed period (77%-71%). Conclusions: It was not possible to establish in a statistically relevant way which of the two methods analysed had a greater effect on postoperative pain. Anyway, the Tap block techique has allowed a shorter time of recovery and, consequently, of movement. As far as breast-feeding is concerned, no connection between postoperative analgesia and breast-feeding has been found.
Introduzione: Diverse sono le tecniche per il controllo del dolore chirurgico e in questo caso post taglio cesareo. Pochi studi hanno indagato su un possibile rapporto tra la tecnica utilizzata, in questo caso Tap block versus elastomero, ed la gestione del dolore e l’esito sull’allattamento. Scopo dello studio: lo scopo dello studio è di fornire una valutazione delle diverse scale di dolore NRS ed individuare differenze per quel che riguarda il movimento, l’allattamento, la sedazione e sull’incidenza di nausea e vomito in due gruppi di pazienti ricoverate in puerperio, sottoposte a differenti metodiche antalgiche. Materiali e metodi: lo studio si è svolto in due fasi, la prima di revisione della letteratura e la seconda di raccolta dati. Sono state arruolate 68 donne che hanno partorito con taglio cesareo presso l’azienda ospedaliera di Padova tra giugno e ottobre 2022. Sono state raccolte informazioni riguardanti le scale NRS di dolore, il livello di sedazione, il movimento e la presenza di nausea e vomito. Dopo il parto e a un mese da esso sono stati somministrati due questionari riguardanti l’allattamento. I dati raccolti sono stati analizzati mediante test statistici. Risultati: Nel 53% delle donne campionate è stato utilizzato l’elastomero come tecnica antalgica post operatoria, mentre al restante 47% è stato effettuato il Tap block. In relazione alle NRS, nelle prime 6 ore dopo il parto il dolore medio delle pazienti con elastomero è risultato essere di 5,88 mentre è stato di 4,19 nelle pazienti sottoposte a Tap block. Nonostante questa differenza dal punto di vista statistico non è risultato un rapporto statisticamente rilevante. Dai p-value ottenuti, solamente dai dati riguardati il movimento è emerso un rapporto statisticamente rilevante infatti il 56,3% della pazienti Tap block si è alzata entro le 6-12h a differenza del 27% delle pazienti con elastomero. Per quanto riguarda le altre variabili, tra cui, il livello di sedazione, la presenza di nausea e vomito non sono risultate differenze rilevanti tra i due gruppi. Infine dall’analisi delle risposte dei questionari non sono emerse considerazioni statisticamente rilevanti ma è stato evidenziato un trend per quel che riguarda l’esclusività dell’allattamento sia nei primi giorni che a un mese dal parto a favore del gruppo di donne sottoposte al Tap block. In entrambi i gruppi la maggioranza delle pazienti ha fatto il contatto pelle a pelle (69%-78%) e il primo attacco (80%-75%) nelle prime ore, non ha riscontrato difficoltà (41%-31%) a un mese dal parto ed ha continuato ad allattare nel periodo analizzato (77%-71%) Conclusioni: Non è stato possibile determinare in modo statisticamente rilevante quale delle due tecniche campionate abbia avuto un maggior effetto sul dolore post operatorio. La tecnica del Tap Block ha permesso però un minor tempo di ripresa e di conseguenza di deambulazione nelle pazienti che sono state sottoposte ad essa. Dal punto di vista dell’allattamento non è risultata esserci una correlazione tra analgesia post operatoria ed esito di quest’ultimo.
INFLUENZA DELL’UTILIZZO DELLA MORFINA INTRATECALE E TAP BLOCK VERSUS ELASTOMERO ENDOVENOSO SUL DOLORE POST-OPERATORIO E SULL’ALLATTAMENTO IN PAZIENTI SOTTOPOSTE A TAGLIO CESAREO ELETTIVO
MARUZZI, BEATRICE
2021/2022
Abstract
Introduction: there are different techniques to control surgical pain, precisely in this study post C-section pain. Few studies have examined a possible relationship between the technique used, in this case Tap block vs elastomer, and the control of pain and its consequences on breast-feeding. Objectives: the goal of this study is to provide an assessment of the different pain scales NRS and to identify differences with reference to movement, breast-feeding, sedation and occurrence of nausea and vomiting in two different groups of patients, post-partum hospitalised, who were subjected to different antalgic therapies. Materials and methods: the study has been carried out in two phases, firstly a revision of the specific literature and secondly a collection of data. Sixty-eight women who had a C-section at the Azienda ospedaliera in Padua between the period June-October 2022 were enrolled. The information collected has taken into consideration NRS pain scales, sedation level, movement and occurrence of nausea and vomiting. Two questionnaires concerning breast-feeding were given to the women after delivery and a month later. The data collected have been analysed through statistical tests. Results: 53% of the recruited women were subjected to elastomer as post operative anthalgic therapy, while the remaining 47% went through Tap block. With reference to the NRS pain scales, in the first 6 hours after delivery the average pain in the patients with elastomer proved to be 5,88, while it was 4.19 in the patients with Tap block. Despite this difference, from a statistical point of view no report statistically relevant has emerged. From the obtained p-values, only the data concerning movement have shown a statistically relevant report. Actually, 56,3% of the Tap block patients stood up from bed within 6-12 hours after delivery, while 27% of the patients with elastomer did not. With reference to the other variables, among which the level of sedation and the occurrence of nausea and vomiting, no relevant differences have emerged in the two groups. Finally, the analysis of the answers of the questionnaires have revealed no statistically relevant considerations, but they have shown that women treated with Tap block exclusively breastfed their babies both in the first days after delivery and after a month. In both groups, the majority of patients had skin – to- skin contact with their babies (69%-78%) and first breast-feed (80%-75%) in the first hours, they did not face any difficulties (41%-31%) after a month from delivery and continued to breastfeed during the analysed period (77%-71%). Conclusions: It was not possible to establish in a statistically relevant way which of the two methods analysed had a greater effect on postoperative pain. Anyway, the Tap block techique has allowed a shorter time of recovery and, consequently, of movement. As far as breast-feeding is concerned, no connection between postoperative analgesia and breast-feeding has been found.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/38348